Peitz U, Raps S, Plein K, Leodolter A, Hotz Dagger J, Malfertheiner P
Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität Magdeburg, Germany.
Dtsch Med Wochenschr. 2004 Mar 26;129(13):671-5. doi: 10.1055/s-2004-820578.
Conflicting data regarding new onset or deterioration of gastroesophageal reflux disease (GORD) following eradication of Helicobacter pylori infection have been reported. Successful eradication therapy may influence gastric acid output. The study aimed to to investigate whether patients with pre-existing GORD or peptic ulcer disease may experience deterioration of GORD.
75 consecutive patients of a prospective longitudinal study (median age 66 years, n = 45 males) had received successful H. pylori eradication therapy because of the following main diagnosis: peptic ulcer (n = 37), GORD (n = 16), functional dyspepsia (n = 22). Two to three years later, they had an interview regarding the course of their dyspeptic and reflux symptoms. Negative H. pylori status at present was confirmed by (13)C-urea breath test in all patients. Ten patients were excluded because of proton pump inhibitor treatment.
Patients with deterioration of GORD (new onset or increasing reflux symptoms) were found significantly more frequently in the group with functional dyspepsia (36 %) compared to pre-existing GORD (16 %) or peptic ulcer disease (5 %). Improvement of pre-existing reflux complaints were reported mostly by patients with peptic ulcer disease. There was no significant impact of initial reflux manifestations like reflux symptoms or reflux oesophagitis on the course.
During long-term follow-up after H. pylori eradication, patients experience improvement as frequently as deterioration of reflux symptoms. There is a tendency towards improvement of reflux symptoms if peptic ulcer disease had been the indication for eradication, but towards deterioration in patients with initial functional dyspepsia. A clinical relevant prediction, however, is not feasible.
关于根除幽门螺杆菌感染后胃食管反流病（GORD）新发或病情恶化的数据存在矛盾。成功的根除治疗可能会影响胃酸分泌。本研究旨在调查既往患有GORD或消化性溃疡疾病的患者是否会出现GORD病情恶化。
一项前瞻性纵向研究纳入了75例连续患者（中位年龄66岁，男性45例），这些患者因以下主要诊断接受了成功的幽门螺杆菌根除治疗：消化性溃疡（37例）、GORD（16例）、功能性消化不良（22例）。两到三年后，对他们进行了关于消化不良和反流症状病程的访谈。所有患者均通过（13）C - 尿素呼气试验证实目前幽门螺杆菌呈阴性。10例患者因使用质子泵抑制剂治疗被排除。
与既往患有GORD（16%）或消化性溃疡疾病（5%）的患者相比，功能性消化不良组中GORD病情恶化（新发或反流症状加重）的患者明显更多（36%）。消化性溃疡疾病患者大多报告既往反流症状有所改善。初始反流表现如反流症状或反流性食管炎对病程无显著影响。
在幽门螺杆菌根除后的长期随访中，患者反流症状改善和恶化的频率相当。如果根除的指征是消化性溃疡疾病，反流症状有改善的趋势，但初始为功能性消化不良的患者则有恶化的趋势。然而，进行临床相关预测是不可行的。
